U.S. patent number 6,344,040 [Application Number 09/266,453] was granted by the patent office on 2002-02-05 for device and method for removing gas and debris during the photodisruption of stromal tissue.
This patent grant is currently assigned to Intralase Corporation. Invention is credited to Tibor Juhasz, Ronald M. Kurtz.
United States Patent |
6,344,040 |
Juhasz , et al. |
February 5, 2002 |
Device and method for removing gas and debris during the
photodisruption of stromal tissue
Abstract
A device for removing gas and debris from the stroma of an eye
during ophthalmic laser surgery includes a contact lens that is
formed with a recessed chamber. The device also includes a suction
pump that is connected in fluid communication with the recessed
chamber. In operation, the stroma is stabilized in the recessed
chamber of the contact lens and an opening into the stroma is
created. This opening is created either by the laser beam, or by a
probe that is mounted on the contact lens to penetrate the stroma
while the stroma is stabilized in the recessed chamber of the
contact lens. Then, simultaneously or subsequently, as a laser beam
is directed through the contact lens to photodisrupt tissue in the
stroma the suction pump is activated to aspirate the resultant gas
and debris through the opening and out of the stroma.
Inventors: |
Juhasz; Tibor (Irvine, CA),
Kurtz; Ronald M. (Ann Arbor, MI) |
Assignee: |
Intralase Corporation (Ann
Arbor, MI)
|
Family
ID: |
23014652 |
Appl.
No.: |
09/266,453 |
Filed: |
March 11, 1999 |
Current U.S.
Class: |
606/4; 606/5 |
Current CPC
Class: |
A61F
9/00827 (20130101); A61F 9/009 (20130101); A61B
2218/008 (20130101); A61F 2009/00872 (20130101) |
Current International
Class: |
A61F
9/009 (20060101); A61F 9/007 (20060101); A61F
9/01 (20060101); A61B 18/00 (20060101); A61B
018/18 () |
Field of
Search: |
;606/4-6,13,17
;607/89,91 |
References Cited
[Referenced By]
U.S. Patent Documents
Other References
Marshall, John, et al.; Photoablative reprofiling of the cornea
using an excimer laser: Photorefractive keratectomy; Lasers in
Ophthalmology, vol. 1, No. 1 pp. 21-48 (1986). .
Habib, Maged S. M.D., et al, Mass Spectrometry Analysis of the
Cavitation Bubbles By-Products of Instrastromal Photorefractive
Keratectomy (IPRK) with the ND:YLF Picosecond Laser, pp. 1-8; Jul.
18, 1994..
|
Primary Examiner: Gibson; Roy
Attorney, Agent or Firm: Fulbright & Jaworski L.L.P.
Claims
What is claimed is:
1. A device for removing gas and debris from inside the stroma of
an eye caused by the photodisruption of stromal tissue during
ophthalmic laser surgery which comprises:
a contact lens formed with a recessed chamber for receiving and
stabilizing the cornea of an eye therein;
a laser system for generating a laser beam, said laser beam being
directed through said contact lens to photodisrupt tissue in the
stroma of the cornea;
a cutting means for creating an external opening into the stroma to
access the gas and debris caused by the photodisruption of tissue;
and
a suction means positioned in fluid communication with the external
opening for aspirating the gas and debris from the stroma through
the opening and through the lens for removal therefrom.
2. A device as recited in claim 1 wherein the contact lens
comprises:
a lens member having an anterior surface and an aplanation surface,
the aplanation surface being substantially parallel to the anterior
surface;
a skirt surrounding the aplanation surface and extending outwardly
therefrom to define the recessed chamber therebetween; and
a first suction line for connecting the suction means in fluid
communication with the recessed chamber to create a partial vacuum
therein between the aplanation surface and the cornea of the eye to
stabilize the cornea against the contact lens.
3. A device as recited in claim 2 wherein the skirt is formed with
a groove to establish a suction channel between the aplanation
surface and the skirt.
4. A device as recited in claim 3 wherein the first suction line is
connected in fluid communication with the recessed chamber through
the suction channel.
5. A device as recited in claim 1 wherein the cutting means for
creating the external opening into the stroma is the laser
system.
6. A device as recited in claim 5 wherein the suction means is in
fluid communication with the recessed chamber of the contact lens,
and the recessed chamber is in fluid communication with the
external opening into the stroma.
7. A device as recited in claim 1 wherein the contact lens is made
of a clear medical grade plastic.
8. A device for removing gas and debris from inside the stroma of
an eye caused by the photodisruption of stromal tissue during
ophthalmic laser surgery which comprises:
a means for stabilizing the cornea of an eye;
a cutting means for creating an external opening into the stroma of
the cornea to access the gas and debris caused by the
photodisruption of tissue;
a means for establishing a fluid channel, the fluid channel being
in fluid communication with the opening into the stroma; and
a suction means positioned over said external opening in fluid
communication with the fluid channel for aspirating the gas and
debris from the stroma through the opening and through the fluid
channel for removal of the gas and debris from the stroma.
9. A device as recited in claim 8 wherein the means for stabilizing
the cornea is a contact lens comprising:
a lens member having an anterior surface and an aplanation surface,
the aplanation surface being substantially parallel to the anterior
surface;
a skirt surrounding the aplanation surface and extending outwardly
therefrom to define a recessed chamber therebetween; and
a first suction line for connecting the suction means in fluid
communication with the recessed chamber to create a partial vacuum
therein between the aplanation surface and the cornea of the eye to
stabilize the cornea against the contact lens.
10. A device as recited in claim 9 wherein the skirt is formed with
a groove to establish a suction channel between the aplanation
surface and the skirt.
11. A device as recited in claim 10 wherein the first suction line
is connected in fluid communication with the recessed chamber
through the suction channel.
12. A device as recited in claim 9 wherein the means for
establishing a fluid channel is the recessed chamber and the
cutting means for creating the external opening into the stroma is
the laser system.
13. A device as recited in claim 12 wherein the suction means is in
fluid communication with the recessed chamber of the contact lens,
and the recessed chamber is in fluid communication with the opening
into the stroma.
14. A device as recited in claim 9 wherein the cutting means for
creating the external opening into the stroma is a probe, the probe
being mounted on the contact lens, and wherein the device further
comprises a second suction line for connecting the probe in fluid
communication with the suction means.
15. A device as recited in claim 14 wherein the means for
establishing a fluid channel is the probe.
16. A method for removing gas and debris from the stroma caused by
the photodisruption of stromal tissue during ophthalmic laser
surgery which comprises the steps of:
stabilizing the cornea of an eye with a contact lens, the contact
lens being formed with a recessed chamber for receiving the cornea
therein;
activating a laser system to generate a laser beam, the laser beam
being directed through the contact lens to photodisrupt tissue in
the stroma of the cornea;
creating an external opening into the stroma to access the gas and
debris caused by the photodisruption of tissue; and
aspirating the gas and debris from the stroma through the external
opening and through the lens for removal therefrom.
17. A method as recited in claim 16 wherein the creating step is
accomplished with the laser system.
18. A method as recited in claim 16 wherein the creating step is
accomplished with a probe mounted on the contact lens with the
probe extending into the recessed chamber of the contact lens.
19. A method as recited in claim 18 wherein the contact lens is
made of a clear medical grade plastic.
20. A device for removing gas and debris caused by the
photodisruption of stromal tissue during ophthalmic laser surgery
which comprises:
a contact lens formed with a recessed chamber for receiving and
stabilizing the cornea of an eye therein;
a laser system for generating a laser beam, said laser beam being
directed through said contact lens to photodisrupt tissue in the
stroma of the cornea;
a probe for creating an external opening into the stroma to access
the gas and debris caused by the photodisruption of tissue, the
probe being mounted on the contact lens;
a suction means positioned in fluid communication with the external
opening for aspirating the gas and debris from the stroma through
the opening and through the lens for removal therefrom.
Description
FIELD OF THE INVENTION
The present invention pertains generally to devices which are
useful in ophthalmic laser surgery. More particularly, the present
invention pertains to contact lenses which will stabilize the eye
of a patient during ophthalmic surgery. The present invention is
particularly, but not exclusively, useful as a contact lens which
stabilizes the eye and also aspirates the gas and debris that is
created as stromal tissue is photodisrupted during intrastroma
ophthalmic laser surgery.
BACKGROUND OF THE INVENTION
During laser surgery, the interaction of the laser beam with body
tissue involves a phenomenon which is generally referred to as
photodisruption. The result of photodisruption on the affected
tissue is really three-fold. In part, the tissue is vaporized. In
part, there are mechanical effects on the tissue which become
manifest in the tearing, separation and division of the affected
tissue. Finally, there may be thermal effects which include
charring and scorching of the affected tissue. The consequences are
mixed. Along with the beneficial and intended consequences for a
particular surgical procedure (i.e. the cutting or removing of
tissue) there are also unwanted consequences of photodisruption.
These unwanted consequences typically result from the generation of
gas and tissue debris which have the potential to disrupt the
surgical procedure. Preferably, the unwanted gas and debris can be
removed from the surgical site.
For laser surgical procedures which are accomplished on external or
exposed tissue, the problem of removing gas and debris from the
surgical site is relatively easily solved. In this case, the gas
will dissipate and the debris can be easily washed away or
aspirated. The case is quite different, however, where internal
tissue is involved. Specifically, in the case of intrastromal
procedures wherein a specific volume of internal stromal tissue is
to be photodisrupted, there is a real concern about how to best
remove the unwanted gas and debris. Clearly, this gas and debris
needs to be removed for several reasons. These reasons include: 1)
the need to reduce the unwanted build up of gas pressure in the
stroma during a surgical procedure; and, 2) the need to remove
debris particles and obstructions which could otherwise interfere
with the laser beam during subsequent photodisruption of additional
stromal tissue. In order to address these needs, reliance on
something more than the body's own ability to resorb the affected
tissue is necessary.
In light of the above, it is an object of the present invention to
provide a device which will effectively reduce the unwanted build
up of gas pressure in the stroma during ophthalmic laser surgery.
Another object of the present invention is to provide a device
which will effectively remove debris particles and obstructions
from the stroma which could otherwise interfere with the subsequent
photodisruption of additional tissue. Yet another object of the
present invention is to provide a device for removing the gas and
debris that results during the photodisruption of stromal tissue
which is easy to use, relatively simple to manufacture, and
comparatively cost effective.
SUMMARY OF THE PREFERRED EMBODIMENTS
A device for removing gas and debris from the stroma of an eye
during intrastromal ophthalmic laser surgery includes a contact
lens and a suction apparatus which is interconnected with the
contact lens. Further, the contact lens is formed with a recessed
chamber, and the suction apparatus is connected in fluid
communication with the recessed chamber. With this combination,
when the recessed chamber of the contact lens is positioned over
the eye, and the suction apparatus is activated, the cornea of the
eye is drawn into the recessed chamber to hold the cornea against
the contact lens. This action also stabilizes the eye during
subsequent laser surgery.
Once the cornea of the eye has been stabilized by the contact lens,
a laser source can be activated to generate a laser beam. For
purposes of the present invention, this laser beam will be directed
through the contact lens to perform the desired intrastromal
ophthalmic laser surgery. When doing so, stromal tissue is
photodisrupted by the laser beam in a predetermined manner. It is
well known, however, that as stromal tissue is photodisrupted by a
laser beam, gas and debris are formed as by-products in the stroma.
To compensate for this result, and avoid the unwanted consequences
which can ensue if nothing is done, the gas and debris need to be
removed as quickly 10 as possible. In accordance with the present
invention, the removal of gas and debris from inside the stroma can
be accomplished by aspiration in either of two ways. For both of
these ways, a fluid communication channel into the stroma needs to
be created.
With one embodiment of the present invention for removing gas and
debris from the stroma during intrastromal ophthalmic laser
surgery, the laser system itself is used to create an external
opening into the stroma. Importantly, in addition to establishing a
fluid communication channel with the interior of the stroma, this
external opening needs to remain in fluid communication with the
recessed chamber during the surgical procedure. Stated in the
negative, the external opening into the stroma can not be created
wherever there is a contact between the cornea and the contact lens
that would obstruct the external opening. Then, with the opening
undisturbed, subsequent activation of the laser system can be
accomplished in a manner which will place the gas and debris that
results from the photodisruption of tissue in fluid communication
with the external opening. The external opening, of course, will
also be in fluid communication with the recessed chamber, and the
recessed chamber will be in fluid communication with the suction
apparatus. Accordingly, the suction apparatus can aspirate the gas
and debris from the stroma and thereby remove this material from
the eye.
With another embodiment of the present invention for removing gas
and debris from the stroma during intrastromal ophthalmic laser
surgery, a hollow probe is mounted on the contact lens to extend
into the recessed chamber. Thus, for this embodiment of the present
invention, the suction apparatus is connected in fluid
communication with the recessed chamber through the probe. With
this configuration, when the recessed chamber of the contact lens
is positioned over the cornea, and the suction device is activated
to draw the cornea into the recessed chamber, the probe will
penetrate into the stroma. Subsequent activation of the laser
system will then need to begin at the tip of the probe and continue
from there through the stroma as desired. In this manner, the tip
of the probe will remain in fluid communication with the stromal
tissue that is being photodisrupted so that the resultant gas and
debris can be removed from the eye.
BRIEF DESCRIPTION OF THE DRAWINGS
The novel features of this invention, as well as the invention
itself, both as to its structure and its operation, will be best
understood from the accompanying drawings, taken in conjunction
with the accompanying description, in which similar reference
characters refer to similar parts, and in which:
FIG. 1 is a perspective view of the device for removing gas and
debris from the stroma in accordance with the present
invention;
FIG. 2 is a perspective view of the contact lens and suction
apparatus of the present invention, shown detached and isolated
from the laser system;
FIG. 3A is a cross sectional view of the contact lens of one
embodiment of the present invention as seen along the line 3--3 in
FIG. 2;
FIG. 3B is a view of the contact lens as seen in FIG. 3A with the
contact lens in contact with the cornea of an eye;
FIG. 4A is a cross sectional view of another embodiment of the
contact lens of the present invention as seen along the line 3--3
in FIG. 2; and
FIG. 4B is a view of the contact lens as seen in FIG. 4A with the
contact lens in contact with the cornea of an eye.
DESCRIPTION OF THE PREFERRED EMBODIMENT
Referring initially to FIG. 1, a device for removing gas and debris
from the eye during intrastromal ophthalmic laser surgery is shown
and generally designated 10. As shown, the device 10 includes a
laser system 12 which is used to generate a laser beam 14 that can
be used for the particular surgical procedure that is to be
performed. As intended for the present invention, the laser beam 14
will preferably be a pulsed laser beam which includes a train of
pulses. Further, depending on the particular surgical procedure
that is to be performed, and the desires of the attending
physician, the wavelength for light in the laser beam 14 can be
selected from several ranges of wavelengths, and each pulse in the
beam 14 can have a duration that is in the range of picoseconds or
femptoseconds. FIG. 1 also shows that the device 10 includes a
retainer 16 which is used to hold a contact lens 18 in a
predetermined spatial relationship with the laser system 12. For
purposes of the present invention, the contact lens 18 is
preferably a rigid structure which is made of glass or a clear
medical grade plastic.
As intended for the present invention, the laser beam 14 is
directed through the contact lens 18 and toward the eye 20 of a
patient. More specifically, the laser beam 14 is directed into the
stroma 22 of the cornea 24 of eye 20, where its focal point is
moved along a predetermined path to photodisrupt stromal tissue. As
mentioned above, the by-products of this photodisruption include
gas and debris which needs to be removed from the stroma 22.
In both FIGS. 1 and 2 it will be seen that the device 10 also
includes a suction pump 26 which is connected in fluid
communication with the retainer 16 by a first suction line 28.
Additionally, FIGS. 1 and 2 shown that the device 10 may include a
second suction line 30 which directly connects the suction pump 26
in fluid communication with the contact lens 18. The particulars of
these connections, and the detailed structure of the contact lens
18 will be best appreciated by reference to FIGS. 3A, 3B, 4A and
4B.
FIG. 3A shows that a contact lens 18 in accordance with the present
invention has a substantially flat anterior surface 32, and a
substantially flat aplanation surface 34. As shown, the anterior
surface 32 is generally parallel to the aplanation surface 34. It
is to be appreciated, however, that for an alternate embodiment of
the present invention, the anterior surface 32 and the aplanation
surface 34 may be curved to conform with the radius of curvature of
the eye. In any event, the resultant optical interaction between
these surfaces 32, 34 is the same for all configurations.
Additionally, FIG. 3A shows that the contact lens 18 includes a
skirt 36 which extends outwardly from the aplanation surface 34,
and surrounds the aplanation surface 34 to define a recessed
chamber 38 which is located between the aplanation surface 34 and
the skirt 36. In further detail, FIG. 3A shows that in the recessed
chamber 38 at the interface between the skirt 36 and the aplanation
surface 34, the contact lens 18 is formed with a groove 40.
Still referring to FIG. 3A, it will be seen that the first suction
line 28 is connected with the retainer 16 and is placed in fluid
communication with the groove 40 in recessed chamber 38 via a
passageway 42. With this connection it will be appreciated that the
suction pump 26 is also in fluid communication with the recessed
chamber 38. Accordingly, when the contact lens 18 is positioned on
the eye 20 with the recessed chamber 38 against the cornea 24, and
a partial vacuum is drawn in the recessed chamber 38 by the suction
pump 26, the cornea 24 will be drawn toward and flattened against
the aplanation surface 34 of the lens 18 substantially as shown in
FIG. 3B. In this configuration (FIG. 3B), intrastromal ophthalmic
laser surgery can be performed on the stroma 22.
As suggested in FIG. 3B, with the cornea 24 stabilized in recessed
chamber 38 of contact lens 18, an external opening 44 in the
anterior surface of cornea 24 can be made which will establish
fluid communication with the interior of the stroma 22.
Accordingly, as intrastromal laser surgery proceeds into the stroma
22 from external opening 44, the gas and debris 46 which results
from photodisruption of the stromal tissue will be aspirated by the
action of the suction pump 26. Specifically, for this embodiment of
the device 10, the gas and debris 46 from inside the stroma 22 will
be aspirated through the external opening 44 and into the recessed
chamber 38. The gas and debris 46 will then be further aspirated
from the recessed chamber 38 through the passageway 42 and first
suction line 28 into a collection vial (not shown) in the suction
pump 26. As will be appreciated by the skilled artisan, for this
embodiment of the present invention, it is important that the
opening 44 remain in fluid communication with the recessed chamber
38. This condition can, of course, be insured by first stabilizing
the contact lens 18 on the eye 20, and then appropriately selecting
the location for the external opening 44 on a portion of the
anterior surface of the cornea 24 that is not in direct contact
with the lens 18.
Another embodiment for the contact lens 18' of the present
invention is shown in FIG. 4A. The specific difference between the
contact lens 18 of FIG. 3A, and the contact lens 18' of FIG. 4A, is
that for the embodiment shown in FIG. 4A, there is a second suction
line 30 which is connected in fluid communication with a hollow
probe 48. More specifically, as shown in FIG. 4A, the probe 48 is
mounted on the contact lens 18' to extend from the aplanation
surface 34 and into the recessed chamber 38. Accordingly, when the
contact lens 18' is positioned over the eye 20, and the suction
pump 26 is activated to create a partial vacuum in the recessed
chamber 38, the cornea 24 will be drawn into the recessed chamber
38. This will then cause the tip 50 of probe 48 to puncture or
penetrate the anterior surface of the cornea 24. With this
penetration, the tip 50 of probe 48 creates an external opening 52
through which it will become embedded into the stroma 22. Because
the probe 48 is hollow, the suction pump 26 is in direct fluid
communication with the exposed tip 50 of probe 48. Consequently, by
beginning an intrastromal laser surgery at the tip 50, and
thereafter progressing contiguously therefrom through the stroma
22, any gas and debris 46 which is created during surgery can be
effectively aspirated. Specifically, this gas and debris 46 will be
aspirated through the probe 48, and through the second suction line
30, back to a collection vial (not shown) in the suction pump
26.
While the particular Device and Method for Removing Gas and Debris
During the Photodisruption of Stromal Tissue as herein shown and
disclosed in detail is fully capable of obtaining the objects and
providing the advantages herein before stated, it is to be
understood that it is merely illustrative of the presently
preferred embodiments of the invention and that no limitations are
intended to the details of construction or design herein shown
other than as described in the appended claims.
* * * * *